Vascular Access Communication & Patient Advocacy PDF

# Section V: Communication and Patient Advocacy ## Clinician Focused ### A. Care Coordination Across Settings - Care site transitions should include a formalized, standardized document to travel with the patient that includes detailed information regarding the patient's indwelling VAD. Verbal tran...

# Section V: Communication and Patient Advocacy ## Clinician Focused ### A. Care Coordination Across Settings - Care site transitions should include a formalized, standardized document to travel with the patient that includes detailed information regarding the patient's indwelling VAD. Verbal transition communication should supplement, not replace, this document. - The transition document should include at least information on type of device, size of device, date placed, insertion site, exit site, external and internal measurements, date of last dressing and needleless connector change, upper arm circumference baseline measurement if PICC, tip location, method used for tip location verification and any other pertinent VAD information. Additionally, include information and orders for expected therapy including doses given, expected length of therapy and patient's reaction to treatment. - Provide education to the patient and caregiver regarding VAD details, care and therapy including expected length of therapy and the expectation of care variations in different settings. - Consider costs of therapy and provisions of insurance coverage (if any) prior to transitions to non-acute care settings as part of discharge planning. Costs and insurance limitations may guide selection of VAD, care setting, and therapy. ### B. Vascular Access Competencies - **Definitions** - Competency: Demonstration of knowledge, skills, and ability at a defined level of expertise - Clinical Competency (Dr. Benner Stages of Clinical Competence): - Novice: No experience in the skills they need to perform - Advanced beginner: Able to demonstrate marginally acceptable performance - Competent: Able to adequately perform the skill after conscious, abstract, and analytic contemplation of the problem or situation - Proficient: Holistic understanding of the problem or situation and confidently performs the skill - Expert: Intuitively grasps problems and situations and appears to effortlessly perform the skill - Clinical Competency in Medicine: Generally defined by specialty area and includes knowledge, skills, attitudes, and the ability to translate and integrate knowledge. - Competency Assessment: An evaluation measuring a set of skills and knowledge; evaluation includes technical skills, critical thinking, and the ability to apply skills and knowledge in the right way, at the right time. - Professional Licensure Examination: A measure of minimal competency in a professional field - Certification: The formal recognition of specialized knowledge, skills and experience demonstrated by achievement of standards identified by a professional organization or entity. - Professional Development (Staff Development): The process of assessing and developing professional competencies. - Standards of Practice: Authoritative statements by which a profession describes the responsibilities for which its practitioners are accountable. - Clinical Practice Guidelines: Systematically developed statements of appropriate care; Issued by reputable, authoritative organizations and based on current and relevant research. ### C. Vascular Access Education - Currently and historically, few school curricula include comprehensive education on vascular access and infusion therapy. - Education relating to vascular access and infusion therapy generally focuses on theory. - Hands-on skills validation in vascular access is often acquired once the clinician is in the workplace. - Vascular access teaching techniques and aids: - Simulator training using models and devices - Virtual simulator training (model or device links to computer screen) - Virtual reality products (models respond with bleeding, vein collapse, etc.) - Anatomical models (e.g., Chester Chest, Peter PICC Line) - Tissue models and cadavers (human, animal) ### D. Interdisciplinary Collaboration - Defined in various ways; generally refers to the process in which individuals from different disciplines collaborate to set goals, determine plans of care, make decisions, and solve problems (e.g., a vascular access specialist, the physician, the bedside nurse, and case management rounding together to formulate a plan of care). - Collaboration is a process (a series of events) and an outcome (a synthesis of different perspectives) and generally has 3 phases: - Problem Setting: Participants negotiate their right to participate. - Direction Setting: Participants work toward agreement on problem/task and determine what needed actions and resources. - Structuring: Agreements are implemented by allocating roles, responsibilities, and resources. ### E. Mentoring - Mentor: A person who teaches, guides, coaches, gives advice and assistance to a less experienced colleague creating a trusting relationship; a mentor also works as a role model for others in any healthcare practice setting. - Approaches: - Traditional One mentor-to-one mentee - Group: One mentor guides and supports a small group of mentees - Team: Several mentors work with small groups of mentees - Electronic (also called e-mentoring): Uses electronic communication (e.g., email, websites) for mentoring process. - Aspects of successful mentoring: - Foster relationships, both formal and informal - Identify mentees' interest and learning needs - Provide resources, offers guidance and support, and suggests learning activities - Verify and document procedural skills if applicable - Facilitate the professional growth and development of a mentee - The mentor cares about the relationship with the mentee ## Patient Focused ### F. Patient and Caregiver Communication - Provide education to the patient and caregiver related to the vascular access device, the medication or infusate, plan of care, potential complications and how to address problems during therapy. - This includes hands-on training for use, care and maintenance topics, as appropriate. - Education should be provided at the appropriate level for the learner and involve a teach-back to verify comprehension. - Educational materials are often available: - Device manufacturers: Produce a variety of vascular access teaching aids, print and online patient education materials, flipcharts, and device models that can be used for demonstration and practice - Professional organizations: Patient guide available from the Association for Vascular Access - Local and online educational programs, materials, and support groups - Educate patient about organizations and resources related to patient safety in healthcare. - Numerous organizations related to patient safety are available online: - National Patient Safety Goals and Speak Up Campaign from The Joint Commission - Oley Foundation-Patient advocacy group specific to enteral and parenteral nutrition. Educational and support materials available in print and online. - CDC-Patient education online materials that can be printed. - Safe Care Campaign - AHRQ PS Net - Institute for Healthcare Improvement ### G. Additional Patient Considerations - **Cognitively Impaired** - The decision-making ability of a person under the influence of drugs, alcohol, or anesthetic (post-op) is determined by the person's ability to understand information, decisional capacity, and voluntarism. These individuals cannot consent for a procedure while impaired. - Verify patient, caregiver, and family health care literacy. - **Mental Illness** - The decision-making ability of a person with a mental illness is determined by the person's ability to understand information, decisional capacity, and voluntarism. - Determination made on a case-by-case basis. - Formal psychiatric evaluation or consultation may be needed as part of the consent process. - **Limited language proficiency** - Language barriers can create disparities in the informed consent process. - Professional interpreters are necessary when communicating with a patient with a language barrier. This could include phone or video remote technologies available at many institutions.